Vascular disorders chapter 26 Flashcards

Question

PAD Nursing Management. Post-procedure monitor: IT CAN BE bypass, amputation etc...

Answer 1

Post procedure monitor: - VS: because you are going to maintain thier BP. There is gonna be bleeding here. - Operative site - CSM checks (Circulation, Sensation, Motion). You don't want to flex anything. - Pain management - Avoid knee flexed position (to allow blood circulation) - Encourage ambulation like after any other surgery.

Answer 2

- Largest artery in the body - Responsible for supplying oxygenated blood to essentially all vital organs - Branches include right and left common carotid, right and left subclavian, right and left coronary, brachiocephalic, celiac trunk, superior and inferior mesenteric, renal, gonadal, and common iliac

Answer 3

Most common vascular problems of the aorta: - Aneurysms (aneurysms and dissections are hard to survive) - Aortoiliac occlusive disease - Aortic dissection

Answer 4

- Localized sac (outpouching) or dilation formed at a weak point in the wall of the artery. The bigger the blood the bigger amount of blood that is gonna be sequestered and the worse the severity. - Classified by its shape or form - Incidence increases with age. Because of the wear and tear of the arteries. It makes sense. - Most common forms of aneurysms are saccular and fusiform: ***Saccular aneurysm projects from only one side of the vessel ***When an entire arterial segment becomes dilated, a fusiform aneurysm develops. Both sides and it looks like a balloon. ***Pseudoaneurysm is a disruption of all layers of the arterial wall resulting in bleeding contained by surrounding structures

Answer 5

Degenerative Congenital Mechanical Penetrating or blunt trauma Inflammatory Infectious

Answer 6

Age Male gender HTN CAD Family history High cholesterol Lower extremity PAD Carotid artery disease Previous stroke Tobacco use Being overweight or obese

Answer 7

-Often asymptomatic -Frequently detected during a routine physical exam or when the patient is examined for an unrelated problem (KUB, abdominal CT scan) -May mimic the pain associated with abdominal or back disorders -May cause back pain, epigastric discomfort, altered bowel elimination, intermittent claudication -May spontaneously embolize plaque causing “blue toe syndrome”

Answer 8

1) Rupture into retroperitoneal (situated or occurring behind the peritoneum) space: - Bleeding may be tamponaded (stopped) by surrounding structures, thus preventing exsanguination and death. - Severe back pain - May/may not have back/flank ecchymosis (Bruise)(Grey Turner’s sign) 2) Rupture into the thoracic or abdominal cavity - Massive hemorrhage - Most do not survive long enough to get to the hospital

Answer 9

Check slide 38

Answer 10

- If ruptured, emergent surgical intervention is required 90% mortality - Preoperative Nursing - Brief expiation of disease process - Planned surgical procedure - Preop routines; bowel prep, NPO, shower - IV antibiotic prior to incision - Expectations after surgery **PACU, tubes, drains, ICU, beta blocker

Answer 11

1) ICU monitoring 48 hours Neuro, cardia, resp function, Renal GI FEN Pain control Monitor graft patency Infection Increase ambulation 2) Discharge teaching Increase ambulation No heavy lifting or staining Teach about signs and symptoms of complications Infection Neurovascular changes

Answer 12

1) Venous thromboembolism: There are usually deep and superficial ones. We are worried about the deep ones. Leg mainly but also in the groin or arm. (VTE) condition: - Blood clots form in the deep veins of the leg, groin, or arm. - DVT and PE - SVT (superficial vein thrombosis 2) Chronic venous insufficiency/post-thrombotic syndrome 3) Leg ulcers -Arterial -Venous -Mixed and other 4) Varicose veins from standing for a long time.

Answer 13

Caused by Virchow’s triad 2/3 must be present: - Endothelial injury - Venous Stasis: It can be from dehydration. Obstruction of blood flow - Hypercoagulability from cancer, pregnancy etc ...

Answer 14

Advanced age, a fib, chronic HF, obesity, ortho surgery, pregnancy/postpartum, prolonged immobility, stroke, varicose veins

Answer 15

Abdominal/pelvic surgery, caustic IV meds, pelvic, hip leg fracturs, history of previous VTE, PICC or central line, IVDU, trauma

Answer 16

Antithrombin II deficiency, smoking, dehydration, malnutrition, increased factor VIII or lipoprotein, high altitude, malignancies, oral contraceptives, sepsis, severe anemia

Answer 17

Pathophysiology Risk factors Endothelial damage Venous stasis Altered coagulation Manifestations Deep veins Superficial veins

Answer 18

- S/Sx Erythema (means redness), edema, warmth Pain - +Homans sign - Complications PE Chronic venous insufficiency Phlegmasia cerulea dolens (very rare) Swollen, blue, painful leg

Answer 19

Labs Coags (google), platelets, H & H, d-dimer Ultrasound CT Venography MR Venography

Answer 20

1) Anticoagulation Heparin bolus or drip gtt, enoxaparin (Lovenox), Coumadin 2)Surgical treatment Venous thrombectomy Inferior vena cava (VC) filter Filters clots Complications can include: Air embolism, improper placement, filter migration, perforation of vena cava

Answer 21

- Early ambulation and leg exercises - Graduated compression stockings - Intermittent pneumatic compression devices - Subcutaneous heparin (unfractionated) (LMWH: low molecular weight heparin) Fondaparinux - Lifestyle changes Weight loss Smoking cessation Regular exercise

Answer 22

Considerations: Be alert for: - Pregnancy - Obesity - Central lines , PICC, PIV () - No mechanical prophylaxis for those with skin breakdown or limb ischemia due to PVD Contraindications for pharmacological DVT prophylaxis : ***Actie or recent bleeding ***Coagulopathy (INR > 1.5 ***Planned surgical procedure in next 6-12 hours ***Thrombocytopenia (<50,000, sometimes < 100,000) ***Bleeding disorders

Answer 23

Damaged valves of the veins that stop the blood from backing up) Deep vein obstruction (deep in the middle of the tube that is the leg as opposed to superficial veins) Congenital venous malformation AV fistula (AV) fistula is an irregular connection between an artery and a vein.)

Answer 24

Damaged valves Deep vein obstruction (vs superficial) Congenital venous malformation AV fistula (artery attaches to vein)

Answer 25

- Brownish, leathery, itchy skin - Ulcers usually above the ankle it makes sense because if the blood can't go back to the heart ut causes it to back up in the feet due to gravity daaaaa then the pressure of all that fluid pushes against the skin and causes an ulcer. - Ulcers are painful when swollen or infected

Answer 26

1) Education 2) Prevention - Avoid standing for prolonged periods - Use of compression stocking or TED hose (a type of socks) - Ambulation/Exercise - Good skin care –inspection and moisturizer - Avoid trauma (to avoid infection) 3) Diet - Increase protein intake/ high-calorie (if medically safe) - Vitamin A & C - Zinc

Answer 27

- History of the condition - Assess pain, peripheral pulses, edema - Treatment depends on the type of ulcer - Assess for presence of infection - Assess nutrition

Answer 28

- History of the condition - Assess pain, peripheral pulses, edema - Treatment depends on the type of ulcer - Assess for presence of infection - Assess nutrition

Answer 29

- Anti-infective therapy depends on the infecting agent ***Oral antibiotics are usually prescribed (BECAUSE it is an opening and an opening can be a port of entry) - Compression therapy - Debridement of wound - Dressings - Other

Answer 30

- Restoring skin integrity **Cleansing wound; positioning; avoiding trauma; avoid heat sources - Improving physical mobility **Physical activity initially restricted to promote healing; gradual progression of activity **Activity to promote blood flow; encourage the patient to move about in bed and exercise upper extremities **Diversional activities **Analgesic agents before scheduled activities (walking or dressing changes) at least 30 min before. - Promoting adequate nutrition **Protein; Vitamins C and A; Iron; Zinc

Answer 31

Rare, progressiveCharacterized by inflammation and thrombus that block blood flow in the upper & lower extremities arms, feetSymptoms include claudication, Raynaud's pain (often mistaken for joint/muscle pain) (If you have Raynaud's phenomenon, your hands may change colour in cold weather and there may be pain, tingling and numbness. These attacks often only last a few minutes, but they can last two to three hours. You may find that moving into a warmer environment often stops the attack.)

Answer 32

- Avoid activities that cause venous stasis (wearing socks that are too tight at the top or that leave marks on the skin, crossing the legs at the thighs, and sitting or standing for long periods) - Elevate the legs 3 to 6 inches higher than the heart level - Encourage to walk 30 minutes each day if there are no contraindications - Wear graduated compression stockings - Overweight patients should be encouraged to begin weight reduction plans

Answer 33

- Lymphangitis: inflammation or infection of the lymphatic channels - Lymphadenitis: inflammation or infection of the lymph nodes (endodentist abcess highland) - Lymphedema: tissue swelling related to obstruction of lymphatic flow **Primary: congenital **Secondary: acquired obstruction

Answer 34

- S&S: localized swelling or redness, fever, chills, sweating, pain - Treat with oral or IV antibiotics based on severity - Nursing: **Mark the cellulitis with a skin pen and date and time, then take a photo as per your agency’s policy **Elevate affected area 3 to 6 inches above heart level (can help to reduce swelling and speed healing.) **Warm, moist packs to site every 2 to 4 hours **Educate regarding prevention of recurrence **Reinforce education about skin and foot care

Answer 35

1) Intermittent arterial vasoocclusion, usually of the fingertips or toes **Raynaud’s disease: primary or idiopathic **Raynaud’s syndrome: associated with other underlying disease such as scleroderma 2) Manifestations: sudden vasoconstriction results in color changes, numbness, tingling, and burning pain 3) Episodes brought on by a trigger such as cold or stress 4) Occurs most frequently in young women 5) Protect from cold and other triggers. Avoid injury to hands and fingers

Answer 36

The pain is caused by too little blood flow to the legs or arms. Claudication is usually a symptom of peripheral artery disease, in which the arteries that supply blood to the arms or legs, usually the legs, are narrowed. The narrowing is usually due to a buildup of fatty deposits (plaques) on the artery walls.

Answer 37

Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood. LDL cholesterol is often referred to as "bad cholesterol", and statins reduce the production of it inside the liver.

Answer 38

A Doppler ultrasound is a noninvasive test that can be used to estimate the blood flow through your blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. A regular ultrasound uses sound waves to produce images, but can't show blood flow.

Answer 39

What is a PTA? Percutaneous transluminal angioplasty (PTA) is a procedure that can open up a blocked blood vessel using a small, flexible plastic tube, or catheter, with a "balloon" at the end of it

Answer 40

A stent is a short, wire mesh tube that acts like a scaffold to help keep your artery open

Answer 41

Warfarin (brand names Coumadin and Jantoven) is a prescription medication used to prevent harmful blood clots from forming or growing larger. Beneficial blood clots prevent or stop bleeding, but harmful blood clots can cause a stroke, heart attack, deep vein thrombosis, or pulmonary embolism.

Answer 42

A pulmonary embolism occurs when a clump of material, most often a blood clot, gets stuck in an artery in the lungs, blocking the flow of blood When a pulmonary embolism happens, a blockage in any of the arteries leads to a decrease in blood flow to lung tissue downstream. The majority of the time, this blockage is caused by a broken off piece of a blood clot commonly associated with deep vein thrombosis. A deep vein thrombosis most commonly develops in the lower legs, below the knee, although a blood clot can form in both superficial and deep veins and also in other parts of the body as well.

Answer 43

It's also known as chronic venous stasis. Chronic venous insufficiency, or CVI, is a condition in which veins have problems moving blood back to the heart.

Answer 44

Hypercoagulability can be defined as the tendency to have thrombosis as a result of certain inherited and/or acquired molecular defects. Clinical manifestations of hypercoagulability can be devastating and even lethal.

Answer 45

superficial reddening of the skin

Answer 46

Homans's sign is often used in the diagnosis of deep venous thrombosis of the leg. A positive Homans's sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis

Answer 47

There are different types of blood thinners: Anticoagulants, such as heparin or warfarin (also called Coumadin), slow down your body's process of the blood cells sticking to themselves and therefore prevent clots. Antiplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets (usually come together when there is injury but inflammation due to HBP/artherosclerosis etc.. or anything else can mimic this)from clumping together to form a clot.

Answer 48

Blood then pools in your lower legs, causing your legs to swell. Since the blood can't flow well in your legs, the swelling may be extreme. This extreme swelling can put so much pressure on your skin that venous ulcers form. Una herida desde fuera hacia dentro por la presion que el edema ejerce en las venas.

Answer 49

sthesia= sensacion !! Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body

Answer 50

is a common bacterial skin infection that causes redness, swelling, and pain in the infected area of the skin.

Answer 51

Varicose veins aren't exclusive to pregnancy, but pregnancy can signal their arrival — or make them worse. The reason: during pregnancy, the blood volume in the body increases by as much as 20 percent, while the number of veins remains the same, meaning more work for the body's vascular system.

Answer 52

A tourniquet's primary purpose is to stop life-threatening external bleeding,

Answer 53

The cause of venous ulcers is high pressure in the veins of the lower leg. The veins have one-way valves that keep blood flowing up toward your heart. When these valves become weak or the veins become scarred and blocked, blood can flow backward and pool in your legs. This is called venous insufficiency. A venous leg ulcer is the most common type of leg ulcer, accounting for more than 60% of all cases. Venous leg ulcers can develop after a minor injury, if persistently high pressure in the veins of the legs has weakened the skin.

Answer 54

Lymphangitis is an acute inflammation of the lymphatic channels caused by an infectious process.Antibiotics are always a component of treatment Lymphangitis is inflammation of lymphatic channels due to infectious or noninfectious causes. Potential pathogens include bacteria, mycobacteria, viruses, fungi, and parasites.

Answer 55

Lymphadenitis is the medical term for enlargement in one or more lymph nodes, usually due to infection.

Answer 56

Lymphedema: tissue swelling related to obstruction of lymphatic flow Primary: congenital Secondary: acquired obstruction

Answer 57

-We want to know how they have been feeling -What is their diet like?

Answer 58

Arms and legs.

Answer 59

- Health history - Medications: Are they medications for hypertension, is it working? Is it available to them? How does it make them feel? Are they gonna be adherent to something that makes them feel terrible? - Risk factors: Diabetes, obesity, smoking, and anything that is going to cause vasoconstriction. - Signs and symptoms of arterial insufficiency: decreased pulses, changing colors - Claudication and rest pain - Color changes - Weak or absent pulses at extremities. We use a doppler if we can't hear it. Grade the pulse from 0 to 4. A normal pulse being +2. - Skin changes and skin breakdown

Answer 60

Major goals include: - Increased arterial blood supply: This can be done by walking, medical management, and being hydrated and well-oxygenated. - Decrease in venous congestion because it doesn't go back to the heart it will affect the arterial blood supply. - Promotion of vasodilatation and prevention of vascular compression, so nothing like tight pants, etc... Bending an extremity at a certain angle. - Relief of pain: We usually use narcotics, and non-steroidal anti-inflammatories because this is an inflammatory process as well (Remember). - Attainment/maintenance of tissue integrity - Adherence to the self-care program: whatever program they have.

Answer 61

- The hallmark symptom is intermittent claudication (pain) described as aching, cramping, or inducing fatigue or weakness - Occurs with some degree of exercise or activity - Relieved with rest (usually 10 minutes or less) & is reproducible - Pain is associated with critical ischemia of the distal extremity and is described as persistent, aching, or boring (rest pain). Basically, it starts as a pain that only happens when you do some activities and then it progresses to resting pain. meaning that even if you are resting it's gonna hurt you. - Ischemic rest pain is usually worse at night and often wakes the patient. This is because the pt is horizontal instead of hanging down. So there is no help from gravity to perfuse those distal areas. So they have to wake up and walk around to relive the pain.

Answer 62

Because there is no O2 and nerve endings are dying.

Answer 63

- Thin, shiny(With PAD, your blood circulation is impaired. The oxygen-rich blood from your heart must pass through narrowed arteries, making the flow of blood slow and inefficient. Shiny skin is known as a “trophic change” and is a form of atrophy or a sign of skin deterioration due to lack of blood flow.), and taut skin (Taut is an adjective that describes skin that is stretched tight, without wrinkles or sagging. Taut skin is not the same as tight skin, as the words "tight skin" imply a dry, uncomfortable tightness.) - Loss of hair on the lower legs - Diminished or absent pedal (You need a doppler to confirm this), popliteal, or femoral pulses - Pallor of the foot with leg elevation - Reactive hyperemia of the foot with dependent position

Answer 64

Excess blood sugar decreases the elasticity of blood vessels and causes them to narrow, impeding blood flow. This can lead to a reduced supply of blood and oxygen, increasing the risk of high blood pressure and damage to large and small blood vessels. So basically if you get a wound on your foot and it's not getting blood supply with nutrients macrophages etc to heal. It's going to become necrotic and you might get an amputation.

Answer 65

¾ occur in the abdominal aorta ¼ occur in the thoracic aorta Most occur below renal arteries. Which is good news. The larger the aneurysm, the greater the risk Etiology and Pathophysiology: The dilated aortic wall becomes lined with thrombi (clots) that can embolize because of the turbulence and change in blood flow. These clots that form can rupture and go to the distal arteries and this leads to acute ischemic symptoms in the distal branches because they stop blood flow.

Answer 66

Superficial vein thrombosis (SVT) refers to a blood clot in a vein near the surface, deep vein thrombosis (DVT) is a clot in a deep vein in the body, usually in the leg. Superficial vein thrombosis can present as pain and inflammation while deep clots can travel to the lungs and cause a pulmonary embolism. Deep vein thrombosis (DVT) is a condition in which a blood clot develops in the deep veins, most commonly in the lower extremities. A pulmonary embolism occurs when a part of the clot breaks off and travels to the lungs, a potential life threat. Venous thromboembolism (VTE) refers to DVT, PE, or both.

Answer 67

Intravenous catheters cause endothelial trauma and inflammation and are often placed in patients who are hypercoagulable, leading to venous thrombosis. The majority (70 to 80 percent) of thrombotic events occurring in the superficial and deep veins of the upper extremity are due to intravenous catheters. DVT occurs in the deeper veins of the arm, typically above the elbow, and in the large internal jugular vein in the neck. Any time a needle or catheter is put into a vein, the vein wall may become irritated or inflamed, which may lead to the development of small blood clots.

Answer 68

Blood then pools in your lower legs, causing your legs to swell. Since the blood can't flow well in your legs, the swelling may be extreme. This extreme swelling can put so much pressure on your skin that venous ulcers form.

Answer 69

1 Peripheral vascular disease (could be any vassel) 2 Peripheral artery disease 3 Peripheral venous disease

Answer 70

It's like CPMC. It's a non invasive procedure to visualize something inside the body.

Answer 71

trans ------luminal Per--------cutaneous

Answer 72

The arteries supplying the legs are the most commonly affected vessels in peripheral vascular disease. When less blood gets to the muscle tissue in the legs, the tissue receives less oxygen and becomes ischemic. Ischemic cells release adenosine, a type of signaling molecule, which is thought to affect nerves in these areas; this is felt as pain. This pain in the legs is often referred to as claudication.

Answer 73

Lymph nodes filter substances that travel through the lymphatic fluid, and they contain lymphocytes (white blood cells) that help the body fight infection and disease. There are hundreds of lymph nodes found throughout the body. They are connected to one another by lymph vessels.

Answer 74

cellulitis is a deeper bacterial skin infection involving the deeper dermis and subcutaneous tissues by normal bacteria that lives in our skin that is not supposed to be there. Risk factors that can allow these bacteria to invade the skin include having previous damage due to insect bites, minor trauma, abrasions, or skin conditions like eczema, as well as previous skin infections like impetigo or a history of cellulitis.

Answer 75

Scleroderma is a connective tissue disease characterized by chronic inflammation, sclerosis, and fibrosis of the skin, blood vessels, and internal organs. T

Answer 76

act or process of forming

Answer 77

Tube fih neboula

Answer 78

this is what causes the blue color in cyanosis or any other decoloration of blood

Answer 79

When a person appears pale, it may be because there is not enough oxygen-rich hemoglobin near the skin's surface.

Answer 80

Because if you get something inserted in your vein it hurts the walls of the vessel and the rest is history inflammation clot etc Any time a needle or catheter is put into a vein, the vein wall may become irritated or inflamed, which may lead to the development of small blood clots.

Answer 81

When you turn the SCS on, it SCS stimulates the nerves in the area where you feel your pain. This stimulation provides PAD treatment by reducing the pain. The electrical pulses mask and modify the pain signal. It keeps the pain signals from reaching your brain

Answer 82

Raynaud's phenomenon is a form of intermittent arteriolar vasoconstriction resulting in inadequate tissue perfusion. This results in coldness, pain, and pallor of the fingertips or toes. Pain is typically intermittent and acute, not chronic, and skin integrity is rarely at risk. In most cases, the patient is not at high risk for injury.

Vascular disorders chapter 26 Flashcards

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